CardioExchange Archive

August 26th, 2012

Prasugrel vs. Clopidogrel in ACS: The TRILOGY Take

John Ryan, MD

TRILOGY author Matt Roe answers CardioExchange’s questions about his team’s study of clopidogrel vs. prasugrel in ACS.

---

August 26th, 2012

TRILOGY at ESC: No Advantage for Prasugrel Over Clopidogrel in Medical ACS Patients

Larry Husten, PHD

The newer antiplatelet agent prasugrel was no better than the old standby clopidogrel for treating patients with acute coronary syndrome (ACS) who are not undergoing revascularization. The results of the TRILOGY ACS (Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes) trial were presented by Matt Roe at the European Society of […]

---

August 13th, 2012

Selections from Richard Lehman’s Literature Review: August 13th

Richard Lehman, BM, BCh, MRCGP

This week’s topics include using existing data for new research; normal weight, diabetes, and non-CVD death; cholesterol levels in U.S. kids; statins and diabetes; HDL-C and MI protection; statin treatment; hypertension treatment; clopidogrel and PPIs; and an analysis behind the “innovation crisis” of the pharmaceutical industry.

---

July 16th, 2012

Does PPI + DAPT = MI?

Richard A. Lange, MD, MBA and L. David Hillis, MD

Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is the standard of care for prevention of coronary stent thrombosis. Unfortunately, DAPT is associated with an increased risk for gastrointestinal hemorrhage. Although this risk can be reduced with the concomitant administration of a proton pump inhibitor (PPI), initial observational studies suggested that PPI use with DAPT is associated with an increased […]

---

July 16th, 2012

Ticagrelor Joins Clopidogrel and Prasugrel in Updated NSTEMI Guidelines

Larry Husten, PHD

Ticagrelor (Brilinta, AstraZeneca) gains equal standing with prasugrel (Effient, Lilly) and clopdiogrel in the newly released focused update of the ACCF/AHA guidelines for unstable angina and non-ST-elevation myocardial infarction (NSTEMI). The change had been widely anticipated since last year’s FDA approval of ticagrelor. “We have put it on equal footing with two other antiplatelet medications, clopidogrel […]

---

May 17th, 2012

FDA Approves Generic Clopidogrel as Plavix Loses Patent Protection

Larry Husten, PHD

For the second time in the past 6 months, a cardiology mainstay drug has lost patent protection and gone generic. Today, the FDA announced that it had approved several generic versions of clopidogrel (Plavix), the antiplatelet drug that for many years was the second best-selling drug in the world. Last November, the best-selling drug of all time, […]

---

April 19th, 2012

Should We Pull the Trigger on Platelet Reactivity Testing (and Put It out of Its Misery)?

Richard A. Lange, MD, MBA and L. David Hillis, MD

“We said it before, and we’ll say it again: an assessment of platelet reactivity by this method doesn’t effectively identify individuals at high risk for a cardiovascular event following PCI.”

---

March 28th, 2012

Proof-of-Concept for Bedside Rapid Genotyping Test of CYP2C19

Larry Husten, PHD

A new point-of-care test can rapidly identify people with a common genetic variant associated with impaired clopidogrel function. The authors claim that this is the first study to demonstrate the feasibility of delivering a genetic test at bedside. In an article published online in the Lancet, Jason Roberts and colleagues report on a new point-of-care test that can identify […]

---

January 17th, 2012

Cangrelor Proposed as Bridge to Surgery

Larry Husten, PHD

As a potent and reversible platelet inhibitor, cangrelor has been proposed for use in a bridging strategy for patients scheduled for surgery who are currently taking clopidogrel or another thienopyridine. To test this strategy, the BRIDGE investigators randomized 210 ACS or stent patients awaiting CABG and taking a thienopyridine to receive either cangrelor or placebo for at […]

---

December 30th, 2011

CYP2C19 Genotyping: Down For The Count?

Richard A. Lange, MD, MBA and L. David Hillis, MD

The controversy over the use of genetic testing to guide antiplatelet therapy reminds us of a WWF (Worldwide Wrestling Federation) tag team match.   What we agree upon (the match rules): Clopidogrel is a prodrug activated by several enzymes, including CYP2C19, and common genetic variations alter CYP2C19 activity. Here’s where the wrestling match begins: Are the CYP2C19 genetic […]

---